Use Annual Wellness Visits to Amplify Overall Quality

Debra Shute, September 29, 2017

Whether you are delivering primary care through a multi-state integrated system or a rural independent practice, benefits abound in optimizing this fully reimbursed Medicare service.

Despite primary care providers' celebration when the Centers for Medicare & Medicaid Services began paying for the preventive service now known as the Annual Wellness Visit (AWV) in 2011, the majority of PCPs continue to forgo those dollars.

But according to organizations that have made a concerted effort to promote and perfect the service, revenue is far from the only benefit of a strong AWV strategy.

Success key No. 1: Educate providers

Nationally, in 2016, 19.8% of eligible Medicare Part B beneficiaries utilized the AWV, according to a CMS report, despite the fact that CPT codes G0438 for the initial visit and G0439 for a subsequent AWV are paid 100% by Medicare and can be combined with another visit with the addition of a modifier.

The barriers to higher uptake are mostly cultural.

In particular, there is a common perception among physicians that the service is unnecessary.

Dan Hager, MHA
Dan Hager, MHA

"A lot of folks seem to feel that they're already meeting the need that's intended by the AWV without needing to do a distinct service," says Dan Hager, MHA, program manager for physician and ambulatory services for Bon Secours Health System.

Doctors often argue, for example, that the questions raised in the AWV about recommended cancer screening and immunization are already raised during the course of regular primary care, says Hager.

Debra Shute

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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